Hype of MSG | 味精科普
Recently, there’s been a lot of buzz about Uncle Roger's fried rice being sold at Pavilion KL, starting at RM16. Although I haven’t tried it yet, social media is filled with positive reviews.
When we talk about Uncle Roger, MSG inevitably comes to mind. My curiosity about MSG has always been strong, so I decided to dive into the scientific literature. Interestingly, all the potential negative effects of MSG seem to come from preclinical studies where extremely high doses were used. So far, no direct causal link between MSG and health problems in humans has been found.
Even more fascinating is the fact that "Chinese Restaurant Syndrome" may have been a myth all along. Despite the claims, we still don't know who is Dr. Robert Ho Man Kwok, the person who originally wrote the article in the New England Journal of Medicine (NEJM) that sparked the controversy.
However, for my CKD patients, I recommend limiting their intake of foods containing MSG, as these foods often contain other additives like salt and phosphate, which may indirectly have negative effects on overall health and well-being.
最近，关于Uncle Roger的炒饭在吉隆坡Pavilion开卖的消息引起了不少热议，售价从16令吉起。虽然我还没尝试过，但社交媒体上已经充满了好评。
提到Uncle Roger，就不得不想到味精。我一直对味精很感兴趣，所以决定深入阅读相关的科学论文。令人有趣的是，味精的所有潜在负面影响似乎都来自使用极高剂量的动物实验。目前，还没有发现味精与人类健康问题之间存在直接的因果关系。
更有趣的是，“中餐馆综合症”可能一直以来都是一个虚构的传说。尽管争议不断，但我们至今仍不知道是谁写了那篇引发争议的文章——发表在《新英格兰医学杂志》上的 Dr. Robert Ho Man Kwok 的真实身份仍是个谜。
至于肾病患者，我建议他们限制摄入含有味精的食物，因为这些食物通常还含有其他添加剂，如盐和磷酸盐，这可能会间接对整体健康和福祉产生负面影响。
(2.10.2024)
Can hot weather damage the kidneys? | 炎热天气会损伤肾脏?
Up until April this year, the Malaysian Ministry of Health reported 45 cases of heat-related illnesses, highlighting the growing concern over the effects of rising temperatures on public health. Recently, a particularly tragic incident occurred in Pahang, where a young 20-year-old man succumbed to heatstroke after participating in a running event in Teluk Cempedak. This marked the second heatstroke-related death in the region, underscoring the serious and often life-threatening nature of heat-related illnesses.
Malaysia, with its tropical climate, experiences consistently high temperatures throughout the year, particularly during the dry season. However, recent weather patterns have shown an alarming trend of increasingly warmer temperatures, likely exacerbated by the El Niño phenomenon and the broader impacts of global warming. These factors contribute to more frequent and intense heatwaves, making the population more vulnerable to heat-related conditions like heatstroke.
Heatstroke is a severe medical emergency characterized by central nervous system dysfunction, multiorgan failure, and extreme hyperthermia, where body temperatures often exceed 40.5°C. The condition can be categorized into two types: classic (passive) and exertional heatstroke. Both types result from the body’s inability to dissipate excessive heat, but they differ in their underlying causes. Classic heatstroke typically occurs due to prolonged exposure to environmental heat, particularly in individuals with impaired heat-dissipation mechanisms, such as the elderly or those with chronic illnesses. In contrast, exertional heatstroke primarily affects healthy individuals and athletes who engage in intense physical activity. In these cases, the excessive metabolic heat generated during exercise overwhelms the body’s physiological heat-loss mechanisms, leading to dangerous increases in core body temperature.
As a nephrologist, I must emphasize the potential impact of heatstroke on kidney function. One of the most severe complications of heatstroke is acute kidney injury (AKI). When the body is subjected to extreme heat, dehydration and reduced blood flow to the kidneys can occur, leading to kidney damage. In severe cases, this may necessitate temporary dialysis to support kidney function. However, even if a patient recovers from the acute phase, any form of AKI can have long-term consequences on kidney health, potentially increasing the risk of chronic kidney disease in the future.
Preventing heatstroke is much simpler and more effective than treating it. To minimize the risk, it's crucial to stay cool by spending time in air-conditioned environments, using fans, and taking frequent cool showers. It's also important to limit physical exertion during the hottest parts of the day and stay well-hydrated by drinking plenty of water while avoiding alcohol and caffeine. Maintaining regular contact with others, especially those at higher risk, is also vital to ensure safety during periods of extreme heat. These preventive measures are essential during warm weather and heat waves to protect against the dangers of heatstroke.
截至今年四月，马来西亚卫生部报告了45例与高温相关的疾病，这凸显了气温上升对公共健康带来的日益关注。最近，在彭亨州发生了一起特别悲惨的事件，一名20岁的年轻男子在参与直落尖不剎的跑步活动后因中暑而去世。这标志着该地区第二起与中暑相关的死亡事件，进一步强调了高温相关疾病的严重性和潜在的致命性。
马来西亚处于热带气候区，全年气温较高，特别是在旱季。然而，近年来的天气模式显示出一个令人担忧的趋势，气温变得越来越高，这可能是受厄尔尼诺现象和全球变暖的影响所致。这些因素导致了更频繁和更强烈的热浪，使得人们更容易受到像中暑这样的高温相关疾病的影响。
中暑是一种严重的医疗紧急情况，表现为中枢神经系统功能障碍、多器官衰竭以及极度的高热，通常体温超过40.5°C。中暑可以分为两种类型：经典型（被动型）和运动型中暑。两种类型都是由于身体无法散热过多引起的，但它们的根本原因有所不同。经典型中暑通常发生在暴露于环境热中时间较长的人身上，尤其是那些散热机制受损的人群，如老年人或患有慢性病的人。相比之下，运动型中暑主要影响健康个体和运动员，他们在进行高强度体育活动时产生的代谢热量过多，超出了身体的生理散热能力，导致核心体温危险性升高。
作为一名肾脏病医生，我必须强调中暑对肾功能的潜在影响。中暑的严重并发症之一是急性肾损伤（AKI）。当身体暴露在极端高温下时，脱水和肾脏血流量减少可能会导致肾脏损伤。在严重情况下，可能需要暂时性透析来支持肾功能。然而，即使患者从急性期中恢复过来，任何形式的急性肾损伤都可能对肾脏健康产生长期影响，可能增加未来患慢性肾病的风险。
鉴于中暑相关的严重健康风险，预防远比治疗更为有效和易于管理。为了减少中暑的风险，特别是在极端高温期间，采取主动措施保持凉爽至关重要。待在空调环境中是降低体温的最有效方法之一。对于那些家中没有空调的人，可以去购物中心、图书馆或社区中心等公共场所避暑。除了寻找凉爽的环境外，使用风扇可以帮助空气流通，经常淋浴或洗澡也有助于保持安全的体温。
在一天中最热的时段，通常是从中午到下午，限制体力活动也非常重要。如果必须进行锻炼或户外活动，应安排在较凉爽的时间段，如清晨或傍晚，以减少高温暴露的风险。保持良好的水分摄入是另一个关键的预防措施。多喝水有助于补充因出汗而失去的体液，防止脱水，而脱水可能加剧与高温相关的疾病。此外，建议避免饮用可能导致脱水的饮料，如含酒精和咖啡因的饮品。
最后，在热浪期间保持定期的社会联系，尤其是对高风险人群，非常重要。老年人、患有基础疾病的人以及独居者在高温相关疾病面前尤其脆弱。家人、朋友或邻居的定期关怀和探望可以帮助确保这些人保持凉爽和充分的水分摄入，并在出现热应激或中暑症状时提供帮助。
(29.August.2024)
Lifestyle Changes in Blood Pressure Control | 改善生活习惯可以降低血压!
Most of the time, doctors will ask hypertensive patients to take medication to control blood pressure. But wait, are you aware that lifestyle modifications can significantly impact blood pressure control? For example, regular physical activity, a balanced diet, and reducing salt intake can be powerful tools in managing hypertension. Interestingly, some medications taken chronically for other conditions can actually cause an elevation in blood pressure. Examples include Painkillers (NSAIDs), decongestants, certain antidepressants, and corticosteroids. Please consult your doctor before you are taking certain medications!
It’s crucial to remember that hypertension is the second leading cause of kidney failure in Malaysia. Left unchecked, it can lead to serious complications such as heart disease and stroke. So, while medication is important, incorporating healthy lifestyle changes is equally vital in managing hypertension and protecting your overall health.
许多医生会建议高血压患者服用药物来控制病情。然而，其实一些生活习惯的改变同样可以有效地改善我们的血压。例如，保持健康的饮食习惯，多摄入蔬菜和水果，减少盐分和高脂肪食品的摄入；保持规律的运动，每周进行至少150分钟的中等强度有氧运动；减少压力，保持心理健康；戒烟限酒，这些都是有效的措施。
另外，长期服用某些药物也可能导致血压升高。例如，一些止痛药（非甾体抗炎药，譬如布洛芬）、某些鼻腔药，避孕药和某些抗抑郁药物都可能使血压上升。因此，在服用任何药物时，患者应咨询医生，并定期监测血压。
在此我要再次提醒大家，在马来西亚，高血压是导致肾脏衰竭的第二大主要原因。高血压不仅影响肾脏健康，还会增加患心脏病和中风的风险。因此，大家千万不可忽视高血压的危害。及时采取措施控制血压，对于预防严重的健康问题至关重要。
(7.August.2024)
Beware of health fraud scam | 叫声病人提防提防!!
In today's world, people are increasingly aware of financial scams thanks to widespread news coverage and education. They understand that nothing comes easy and that success requires effort. However, many still fall prey to health fraud scams, which can be just as dangerous.
One prevalent example is the promise of "CKD reversal" (Chronic Kidney Disease reversal) through certain products or services. Some healthcare personnel exploit vulnerable patients by using catchy and persuasive language to sell these supposed treatments.
It's important to recognize that while the desire for an easy, stress-free solution is understandable, such treatments are often not evidence-based. Falling for these scams can result in not only financial loss but also the loss of precious time—time that could be used to pursue legitimate, medically sound treatments.
Relying on unproven methods may cause patients to miss the critical window for effective intervention, potentially leading to permanent kidney damage. Always seek advice from qualified healthcare professionals and base your treatment choices on credible, scientific evidence. Don't let the allure of a quick fix compromise your health.
你是否了解金钱诈骗？也许你在新闻中看到过许多这样的案例，因此提高了警惕。事实上，真相很简单：世界上根本没有不劳而获的事情。无论是投资骗局、网络诈骗，还是电信诈骗，骗子们无一不在利用人们想要快速致富的心理。我们必须时刻保持警觉，明白“天上不会掉馅饼”的道理，只有脚踏实地的努力才能获得真正的回报。
除此之外，你知道还有一种更为隐蔽且危险的诈骗——医疗诈骗。医疗诈骗常常打着“快速见效”“无副作用”的旗号，吸引那些急于求医问药的人群。例如，有些声称能够在短时间内显著改善肾脏健康的疗程，看似神奇，但背后往往缺乏科学依据，甚至可能包含有害成分。
如果你轻信这些疗程，它们可能会对你的健康造成永久性的伤害。金钱的损失相对来说是小事，毕竟金钱可以再赚，但一旦肾脏受损，恢复起来就非常困难，甚至会导致终生的健康问题和巨大的医疗开销。肾脏衰竭不仅意味着巨大的经济损失，更是对生命的严重威胁。如果因为这些所谓的疗程而耽误了最佳治疗时机，就算是华佗在世也返魂乏术。或许，你只是质疑或拒绝相信科学的证据吧？
因此，我们必须保持理性，信任正规医疗机构和科学证据，不要被不法分子的花言巧语所蒙骗。记住，保护好自己的健康，是对自己和家人最好的责任。寻找正确的医生咨询，勿浪费时间与生命。
(2.July.2024)
What is KFRE? | 肾脏衰竭风险评估值(KFRE)是什么?
While I was away in Spain, I received the fantastic news that the Kidney Failure Risk Equation (KFRE) will finally be included in specific labs. This is truly excellent news! This validated equation has proven its effectiveness in estimating the risk of kidney disease progression across multiple countries, making it a valuable tool for doctors to identify high-risk patients and devise strategic plans to halt the progression of the disease. Moreover, its implementation brings about heightened awareness among patients regarding their kidney health, empowering them to take proactive measures for their well-being.
Very soon, during your routine blood test at the lab, you can expect the Kidney Failure Risk Equation (KFRE) to be integrated into the renal section. This equation simplifies risk assessment by factoring in your age, gender, creatinine levels, and the amount of protein in your urine. By utilizing this equation, healthcare professionals can provide a personalized estimation of the risk of kidney failure within 2 and 5 years, enabling early intervention and strategic management plans tailored to each individual's needs.
以后不久的未来,我们即将会在血检的报告里看到这个全新的肾脏衰竭风险评估值(KFRE), 这个肾脏衰竭风险评估值在多个国家已被证明能有效的估计肾脏疾病的进展风险. 这让医生们能识别高风险患者并制定一套能够缓慢肾脏衰竭的方案. 而且, 这个肾脏衰竭风险评估值还间接的提高了患者对肾脏健康的意识，使他们能够采取主动措施关注自己的健康.
肾脏衰竭风险评估值(KFRE) 将植入您的年龄、性别、肌酐水平和尿蛋白的含量来预测你在2年和5年内患上肾脏衰竭的可能性. 对于我来说,我觉得这将会大大的降低了大众对eGFR的恐惧, 因为不是每个eGFR 60-90的人都有肾脏病啊!
(17.May.2024)
Are you having CKD stage 2? | 你有第二期肾脏病吗?
During my clinic days, I've encountered numerous elderly patients presenting with blood reports showing eGFR levels between 60 to 90. Understandably, many of them were distressed upon being informed that they were in the early stages of kidney disease. It's heart-wrenching to witness their worry and confusion, especially when I know that their eGFR is often age-related and not indicative of kidney disease.
Recently, The KDIGO has issued a clear statement regarding the labeling of the elderly population as having chronic kidney disease. According to the latest guidelines, elderly individuals should not be labeled as such unless there's significant proteinuria present.
Finally, a voice of reason amidst the sea of uncertainty! This clarity not only alleviates unnecessary anxiety among our senior community but also reinforces what I've been advocating for during my interactions with patients.
Why is this so crucial? Because it means our elders won't be led down paths of unnecessary treatments or herbal remedies that could potentially do more harm than good. It means they can trust in our guidance and expertise without fear of being misled by misconceptions. Nevertheless, It's essential to emphasize the importance of seeking guidance from a qualified nephrologist if there are any doubts or concerns regarding eGFR.
在诊所工作期间，我常常遇到年迈的病人。他们的血液检查报告经常显示出第二期肾衰竭 (eGFR 肾小球滤过率 60-90)，这令他们感到焦虑不安。最令人担忧的是，他们可能会寻求一些民间偏方或非传统治疗方法，而这些方法可能会对他们的肾功能造成更多伤害。
但幸运的是，最近一项新的指南 (改善全球肾脏病预后组织 (KDIGO) 2024年最新慢性肾脏衰竭临床实践指南 )，终于澄清了这个错误的想法。这项指南明确表示，年迈的人的eGFR通常会在60到90之间，但这并不意味着他们患有肾衰竭。相反，这只是他们年龄增长的自然现象。如果他们没有出现尿蛋白，那么他们的肾功能几乎和正常人没有太大差异。因此，我们不应该因为eGFR在60到90之间就过早地将年迈的人诊断为患有肾衰竭。
在与年迈患者沟通时，我们需要更加耐心和细致，向他们解释这一指南的重要性。我们需要向他们传递正确的信息，让他们明白自己的健康状况，并鼓励他们在面对任何健康问题时，寻求合格的医生或专家的帮助和建议。
(20.Mar.2024)
Kidney disease, is not uncommon at all | 肾脏病,就在你我左右
According to estimates from 2017, approximately 10% of the global population, or about 850 million people, suffer from kidney disease. In Malaysia, this issue is even more pronounced, with an estimated 15% of the adult population affected by kidney disease, equating to 1 in every 7 adults being at risk.
Currently, Malaysia has nearly 50,000 patients undergoing dialysis treatment. Data from the Malaysian registry indicates that the primary causes of kidney failure are diabetes, accounting for nearly 50% of cases, followed by hypertension, which is responsible for 35% of cases. (2023)
The critical takeaway here is the importance of managing blood sugar and blood pressure levels as a fundamental strategy for protecting kidney health!
今天我不说病情,我只是粗略的探讨一些有意义的数字。
根据2017年的估计，全球大约有10%的人口，即大约8.5亿人患有肾脏病。在马来西亚据估计，大约15%的成年人口患有肾脏病，这意味着每7个成人中就有1人面临患肾脏病的风险。
目前，马来西亚有近50,000名患者正在接受透析治疗。根据马来西亚的注册数据显示，肾功能衰竭的主要原因有将近50%是由糖尿病引起的，35%是由高血压引起的。(2023)
因此最关键的信息是，管理好血糖和血压是保护肾脏最主要的步骤。
(6. Feb. 2024)
Negative impact of obesity on the kidneys | 不可忽视的肥胖症!
Happy Chinese New Year to all!
As we dive into celebrations and savor the festive feasts, let's not forget an important health note. While indulging in our favorite treats, remember that obesity poses a significant risk to our kidney health. Even being slightly overweight can double the risk of developing kidney disease.
To keep our bodies healthy and enjoy many more celebrations to come, let's aim to follow the recommended guideline of engaging in at least 150 minutes of exercise each week.
祝大家新春快乐
在我们沉浸于庆祝活动和享受节日美食时，别忘了一个重要的健康提示。在我们尽情享受我们最爱的美食时，请记住肥胖是导致肾脏健康风险的重要因素。即使是轻度超重也能将患肾病的风险增加一倍。
为了保持我们的身体健康，并享受更多的庆祝活动，让我们目标遵循推荐的指南，每周至少进行150分钟的运动。祝愿大家新的一年快乐、繁荣、健康 。
(15. Feb. 2024)
Have you had your coffee yet? | 你喝了咖啡吗?
For those with kidney concerns, the question of whether coffee is beneficial has been a pressing one. Recent studies, particularly a notable 2021 analysis, bring good news for coffee lovers: consuming at least two cups per day can indeed support kidney health. This is attributed to the antioxidants in coffee, like polyphenols, which combat oxidative stress and inflammation, factors that can harm kidney function.
However, moderation and medical consultation are essential. Individual health conditions and dietary habits must be considered, making it crucial for those with kidney disease or other health concerns to consult with their doctor before making coffee a regular part of their diet.
Remember, a healthy lifestyle encompasses much more than your coffee intake. Regular exercise, a balanced diet, and maintaining a healthy weight are paramount for overall well-being. Always seek personalized advice from a healthcare provider to ensure your dietary choices align with your health needs.
长期以来，肾脏疾病患者对于是否应该饮用咖啡持谨慎态度。咖啡，这个全球数亿人早晨的必需品，其对健康的影响一直是研究的热点，尤其是对于那些生活中需要特别关注饮食和生活习惯的人群。2021年的一项重要分析给出了让人振奋的消息：对于肾脏健康来说，一天两杯咖啡不仅没有害处，反而可能带来益处。
这项分析揭示了咖啡中的抗氧化剂，特别是多酚类化合物，可能对肾脏具有保护作用。这些成分有助于抵抗体内的氧化应激和炎症反应，这两者都是肾脏疾病进展的常见驱动因素。因此，适量饮用咖啡可能有助于降低慢性肾脏病的风险，为肾病患者提供了一种新的生活方式调整建议。
然而，值得注意的是，尽管研究结果令人鼓舞，但每个人的身体状况和健康需求都是不同的。在将咖啡纳入日常饮食之前，肾病患者应咨询医生，以确定这是否适合他们的个人健康计划。特别是对于那些可能对咖啡中的咖啡因敏感或有其他健康顾虑的人来说，个性化的医疗建议尤为重要。
(1.March.2024)
Prevention is better than cure | 预防胜于治疗
As the world marks another World Kidney Day, it's imperative to underscore the critical importance of kidney health. The kidneys, often underrated in their significance, play a pivotal role in maintaining overall health and well-being. However, the staggering costs associated with renal replacement therapy serve as a stark reminder of the necessity for proactive kidney care.
The financial burden of renal replacement therapy is nothing short of alarming. Consider these figures: Hemodialysis costs approximately RM39,370 per year, peritoneal dialysis RM37,576 per year, and a living-related transplant RM29,482 per year. These numbers highlight not only the immense strain on healthcare systems but also the significant financial implications for individuals and families affected by kidney disease.
Renal transplantation emerges as the most promising solution amidst these daunting costs. Not only does it offer longevity and a superior quality of life for patients, but it also proves to be more cost-effective in the long run. With lower annual expenses compared to dialysis, renal transplantation presents a sustainable option for individuals grappling with kidney failure.
However, while renal transplantation may offer hope, it's crucial to emphasize that prevention remains the cornerstone of kidney health. Adopting a proactive approach through lifestyle modifications, such as maintaining a healthy diet, staying physically active, managing blood pressure, and avoiding tobacco and excessive alcohol consumption, can significantly reduce the risk of kidney disease.
Furthermore, early detection through regular screenings and monitoring of kidney function is paramount. Timely intervention can prevent the progression of kidney disease and mitigate the need for costly treatments down the line.
On this World Kidney Day, let us reaffirm our commitment to prioritizing kidney health. Together, we can make a difference and safeguard the well-being of generations to come. After all, when it comes to kidney health, prevention is undeniably better than cure.
在肾脏世界日这一特殊时刻，我们迫切需要强调肾脏健康的重要性。肾脏是我们身体中不可或缺的器官之一，它承担着过滤血液、排除废物和调节体液平衡等关键功能。然而，面对肾脏疾病的威胁，我们必须认识到预防胜于治疗的重要性。
肾脏疾病不仅会给患者带来身体上的痛苦，还会给经济上造成沉重的负担。治疗肾脏衰竭所需的费用可谓惊人。洗血每年需要花费RM39,370，洗水每年需要花费RM37,576，而肾脏移植则约需花费RM29,482。这些高昂的医疗费用对于患者及其家庭来说无疑是一大财务压力。
在面对肾脏衰竭时，肾脏移植被视为最佳选择。肾脏移植不仅能够延长患者的寿命，提高生活质量，而且在长期来看也更加经济实惠。相比之下，洗血和洗水的治疗费用要高出许多，且需要持续进行，而肾脏移植一次性手术费用虽然高，但却是一种更为持久和经济有效的治疗方式。
然而，我们不应忽视的是，预防肾脏疾病远比治疗肾脏疾病更为重要。通过健康的生活方式，包括合理饮食、适度运动、定期体检等，可以有效降低患上肾脏疾病的风险。此外，注意控制血压、糖尿病等慢性病的发展，也能有效预防肾脏疾病的发生。
在这个肾脏世界日，让我们共同呼吁重视肾脏健康，加强对肾脏疾病的预防和治疗。通过提高公众对肾脏健康的认知水平，倡导健康的生活方式，我们可以共同努力，为构建一个更加健康、幸福的社会贡献一份力量。预防胜于治疗，让我们从现在开始行动起来，保护我们的肾脏健康！
(14.Mar.2024)